FURP.ORG / PUBLIC DATA EXPLORER

OMRON FOUNDATION INC: Form 990PF, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
OMRON FOUNDATION INC (EIN 36-3644055)
Tax period
2021-04-01 to 2022-03-31
Filed
2022-08-04
IRS object ID
202212169349100601
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-08-04T07:59:05-05:00ReturnTs
Tax Period End2022-03-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN346565596PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1155 N WACKER DRIVEAddressLine1Txt
CityCHICAGOCityNm
State AbbreviationILStateAbbreviationCd
ZIP60606ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2021-04-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN363644055EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1OMRON FOUNDATION INCBusinessNameLine1Txt
Business Name Line2C/O OMCABusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlOMROBusinessNameControlTxt
Phone8478437900PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12895 GREENSPOINT PARKWAY NO 100AddressLine1Txt
CityHOFFMAN ESTATESCityNm
State AbbreviationILStateAbbreviationCd
ZIP60169ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJAMES P EBERHARTPersonNm
Person TitleTREASURERPersonTitleTxt
Phone8478437900PhoneNum
Signature2022-08-03SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstJAMESPersonFirstNm
Person LastEBERHARTPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKATHERINE KURTZMANPreparerPersonNm
PTINP01236691PTIN
Phone6172662000PhoneNum
Preparation2022-08-02PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer0TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$1,990,228FMVAssetsEOYAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Rcvd Rev And Expnss$207,306ContriRcvdRevAndExpnssAmt
Interest On Sav Rev And Expnss$911InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm$911InterestOnSavNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss$773NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$773GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$773CapGainNetIncmNetInvstIncmAmt
Other Income Rev And Expnss$170OtherIncomeRevAndExpnssAmt
Other Income Net Invst Incm$0OtherIncomeNetInvstIncmAmt
Total Rev And Expnss$209,160TotalRevAndExpnssAmt
Total Net Invst Incm$1,684TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$0CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$0CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$0CompOfcrDirTrstDsbrsChrtblAmt
Taxes Rev And Expnss$15TaxesRevAndExpnssAmt
Taxes Net Invst Incm$0TaxesNetInvstIncmAmt
Taxes Dsbrs Chrtbl$15TaxesDsbrsChrtblAmt
Other Expenses Rev And Expnss$4,293OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$4,293OtherExpensesNetInvstIncmAmt
Other Expenses Dsbrs Chrtbl$0OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$4,308TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$4,293TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$15TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$538,900ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$538,900ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$543,208TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$4,293TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$538,915TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses-$334,048ExcessRevenueOverExpensesAmt
Net Investment Income$0NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Sav And Temp Cash Invst BOY$2,301,752SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$1,689,445SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$1,689,445SavAndTempCashInvstEOYFMVAmt
Other Investments BOY$0OtherInvestmentsBOYAmt
Other Investments EOY$300,011OtherInvestmentsEOYAmt
Other Investments EOYFMV$300,783OtherInvestmentsEOYFMVAmt
Total Assets BOY$2,301,752TotalAssetsBOYAmt
Total Assets EOY$1,989,456TotalAssetsEOYAmt
Total Assets EOYFMV$1,990,228TotalAssetsEOYFMVAmt
Accounts Payable EOY$22,224AccountsPayableEOYAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$22,224TotalLiabilitiesEOYAmt
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind
Capital Stock BOY$0CapitalStockBOYAmt
Capital Stock EOY$0CapitalStockEOYAmt
Additional Paid In Capital BOY$0AdditionalPaidInCapitalBOYAmt
Additional Paid In Capital EOY$0AdditionalPaidInCapitalEOYAmt
Retained Earning BOY$2,301,752RetainedEarningBOYAmt
Retained Earning EOY$1,967,232RetainedEarningEOYAmt
Tot Net Ast Or Fund Balances BOY$2,301,752TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$1,967,232TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$2,301,752TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$1,989,456TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$2,301,752TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses-$334,048ExcessRevenueOverExpensesAmt
Other Increases$300OtherIncreasesAmt
Subtotal$1,968,004SubtotalAmt
Other Decreases$772OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$1,967,232TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp

FieldValueIRS element (for citing)
PropertyGAIN ON SALE OF INVESTMENT SEC.PropertyDesc
Gross Sales Price$773GrossSalesPriceAmt
Gain Or Loss$773GainOrLossAmt
Gains Minus Excess Or Losses$773GainsMinusExcessOrLossesAmt
FieldValueIRS element (for citing)
Capital Gain Net Income$773CapitalGainNetIncomeAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Investment Income Excise Tax$0InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$0SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$0TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$0EstimatedPlusOvpmtIncmTxAmt
Exempt Frgn Org Tax Wthld At Srce$0ExemptFrgnOrgTaxWthldAtSrceAmt
Extsn Request Income Tax Paid$0ExtsnRequestIncomeTaxPaidAmt
Backup Withholding Withheld$0BackupWithholdingWithheldAmt
Total Payments And Credits$0TotalPaymentsAndCreditsAmt
Es Penalty$0EsPenaltyAmt
Tax Due$0TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (1)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateILOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial Contributors0NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressHTTPS://WWW.OMRONFOUNDATION.OMRON.COM/WebsiteAddressTxt
Individual With BooksJAMES P EBERHARTIndividualWithBooksNm
Phone2245207665PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line12895 GREENSPOINT PARKWAY NO 100AddressLine1Txt
CityHOFFMAN ESTATESCityNm
State AbbreviationILStateAbbreviationCd
ZIP60169ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified PrsnYes (1)FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn0PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Acts Fail To Qlfy As Exceptions0ActsFailToQlfyAsExceptionsInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
NIGEL BLAKEWAY
2895 GREENSPOINT PARKWAYHOFFMAN ESTATESIL60169PRESIDENT/DIRECTOR2.00$0$0$0
K BLAKE THATCHER
2895 GREENSPOINT PARKWAYHOFFMAN ESTATESIL60169SECRETARY/DIRECTOR1.00$0$0$0
JAMES P EBERHART
2895 GREENSPOINT PARKWAYHOFFMAN ESTATESIL60169TREASURER/V.P./DIRECTOR1.00$0$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt
Contractor Paid Over50k0ContractorPaidOver50kCnt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$25,480AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$1,878,343AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$1,903,823TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$1,903,823AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$28,557CashDeemedCharitableAmt
Net Vl Noncharitable Assets$1,875,266NetVlNoncharitableAssetsAmt
Minimum Investment Return$93,763MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$93,763MinimumInvestmentReturnAmt
Total Tax$0TotalTaxAmt
Distributable Before Adj$93,763DistributableBeforeAdjAmt
Recoveries Qualfied Distri$300RecoveriesQualfiedDistriAmt
Distributable Before Ded$94,063DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$94,063DistributableAsAdjustedAmt

PF Qualifying Distributions PFQualifyingDistributionsGrp

FieldValueIRS element (for citing)
Expenses And Contributions$538,915ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Qualifying Distributions$538,915QualifyingDistributionsAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$94,063DistributableAsAdjustedAmt
Undistributed Income PY$0UndistributedIncomePYAmt
Prior Year12019PriorYear1Yr
Prior Year22018PriorYear2Yr
Prior Year32017PriorYear3Yr
Total For Prior Years$0TotalForPriorYearsAmt
Excess Distribution Cyov Yr5$569,480ExcessDistributionCyovYr5Amt
Excess Distribution Cyov Yr4$536,440ExcessDistributionCyovYr4Amt
Excess Distribution Cyov Yr3$601,544ExcessDistributionCyovYr3Amt
Excess Distribution Cyov Yr2$725,901ExcessDistributionCyovYr2Amt
Excess Distribution Cyov Yr1$661,230ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov$3,094,595TotalExcessDistributionCyovAmt
Qualifying Distributions$538,915QualifyingDistributionsAmt
Applied To Year1$0AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$94,063AppliedToCurrentYearAmt
Remaining Distri From Corpus$444,852RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$3,539,447TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$0UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$569,480ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$2,969,967ExcessDistriCyovToNextYrAmt
Excess From Year4$536,440ExcessFromYear4Amt
Excess From Year3$601,544ExcessFromYear3Amt
Excess From Year2$725,901ExcessFromYear2Amt
Excess From Year1$661,230ExcessFromYear1Amt
Excess From Current Year$444,852ExcessFromCurrentYearAmt

Supplementary Information SupplementaryInformationGrp

Application Submission Info ApplicationSubmissionInfoGrp

FieldValueIRS element (for citing)
Recipient PersonKEVIN BUTALEKRecipientPersonNm

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line12895 GREENSPOINT PARKWAY SUITE 100AddressLine1Txt
CityHOFFMAN ESTATESCityNm
State AbbreviationILStateAbbreviationCd
ZIP60169ZIPCd
FieldValueIRS element (for citing)
Recipient Phone2245207660RecipientPhoneNum
Recipient Email AddressOFI@OMRON.COMRecipientEmailAddressTxt
Form And Info And MaterialsHTTPS://WWW.OMRONFOUNDATION.OMRON.COM/GUIDELINES.PHP HTTPS://WWW.OMRONFOUNDATION.OMRON.COM/FILES/OFI%20GRANT%20APPLICATION%20FOR% 20OMRON%20FOUNDATION%20INC%208-29-13.PDFFormAndInfoAndMaterialsTxt
Submission DeadlinesAPPLICATIONS ARE CONSIDERED THROUGHOUT THE YEAR.SubmissionDeadlinesTxt
Restrictions On AwardsSEE FUNDING EXCLUSIONS ON "GUIDELINES" WEBPAGE: HTTPS://WWW.OMRONFOUNDATION.OMRON.COM/GUIDELINES.PHPRestrictionsOnAwardsTxt

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (131 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
ALAMEDA COUNTY COMMUNITY FOOD
PO BOX 2599OAKLANDCA946140599NONEPCCHARITABLE AND EDUCATION$100
ALPHA OMEGA MIRACLE HOME INC
2860 COLLINS AVESAINT AUGUSTINEFL32084NONEPCCHARITABLE AND EDUCATION$450
AMERICAN DIABETES ASSOCIATION
2451 CRYSTAL DR STE 900ARLINGTONVA22202NONEPCCHARITABLE AND EDUCATION$100
AMERICAN HEART ASSOCIATION
7272 GREENVILLE AVEDALLASTX75231NONEPCCHARITABLE AND EDUCATION$12,958
AMERICAN RED CROSS
431 18TH ST NWWASHINGTONDC20006NONEPCCHARITABLE AND EDUCATION$550
AMERICAN TRANSPLANT FOUNDATION
600 17TH ST SUITE 2515 SDENVERCO80202NONEPCCHARITABLE AND EDUCATION$500
AMERICARES
88 HAMILTON AVENUESTAMFORDCT06902NONEPCCHARITABLE AND EDUCATION$700
AMHERST PTA
PO BOX 70AMHERSTMA03031NONEPCCHARITABLE AND EDUCATION$60
ANDERSON ANIMAL SHELTER
1000 SOUTH LAFOXSOUTH ELGINIL60177NONEPCCHARITABLE AND EDUCATION$100
ANN & ROBERT LURIE CHILDREN'S HOSPITAL OF CHICAGO FOUNDATION
225 EAST CHICAGO AVECHICAGOIL60611NONEPCCHARITABLE AND EDUCATION$200
BARTLETT HIGH SCHOOL
701 W SCHICK RDBARTLETTIL60103NONEPCCHARITABLE AND EDUCATION$1,750
BIG BROTHERS BIG SISTERS OF ME
PO BOX 778848CHICAGOIL606778848NONEPCCHARITABLE AND EDUCATION$3,274
BUCKEYE UNION HIGH SCHOOL DISTRICT
1000 EAST NARRAMORE AVENUEBUCKEYEAZ85326NONEPCCHARITABLE AND EDUCATION$500
CALS ANGELS
2422 W MAIN ST UNIT 3BST CHARLESIL60175NONEPCCHARITABLE AND EDUCATION$5,000
CAREGIVERS
1765 GOODYEAR AVENUE SUITE 205VENTURACA93003NONEPCCHARITABLE AND EDUCATION$2,000
CATHOLIC RELIEF SERVICES
PO BOX 17152BALTIMOREMD17152NONEPCCHARITABLE AND EDUCATION$250
CHARLESTON SYMPHONY ORCHESTRA
PO BOX 30818CHARLESTONSC29417NONEPCCHARITABLE AND EDUCATION$800
CHICO STATE UNIVERSITY
400 WEST FIRST STREETCHICOCA959290156NONEPCCHARITABLE AND EDUCATION$110,000
CHILDRENS HOSPITAL LOS ANGELES
4650 SUNSET BLVDLOS ANGELESCA90027NONEPCCHARITABLE AND EDUCATION$4,000
CHILDRENS HUNGER FUND
13931 BALBOA BLVDSYLMARCA91342NONEPCCHARITABLE AND EDUCATION$1,000
CINCINNATI NATURE CENTER
4949 TEALTOWN ROADMILFORDOH45150NONEPCCHARITABLE AND EDUCATION$100
CLEARBROOK
1835 W CENTRAL ROADARLINGTON HEIGHTSIL60005NONEPCCHARITABLE AND EDUCATION$4,000
COASTAL CAROLINA COUNCIL BSA
9297 MEDICAL PLAZA DRNORTH CHARLESTONSC29406NONEPCCHARITABLE AND EDUCATION$200
CONCORDIA LANGUAGE VILLAGES
901 9TH ST SMOORHEADMN56562NONEPCCHARITABLE AND EDUCATION$8,375
CSU CHICO SAE BAJA
400 WEST 1ST STCHICOCA95929NONEPCCHARITABLE AND EDUCATION$1,000
DOCTORS WITHOUT BORDERS
PO BOX 5030HAGARSTOWNMD217415030NONEPCCHARITABLE AND EDUCATION$450
DOCTORS WITHOUT BORDERS USA INC
40 RECTOR STREET 16TH FLOORNEW YORKNY10006NONEPCCHARITABLE AND EDUCATION$2,000
DOG STAR RESCUE
PO BOX 721CANTONCT06019NONEPCCHARITABLE AND EDUCATION$100
DRESS FOR SUCCESS WORLDWIDE
32 EAST 31ST STREETNEW YORKNY10016NONEPCCHARITABLE AND EDUCATION$10
EDUCARE FOUNDATION
16134 WYANDOTTE STREETVAN NUYSCA91406NONEPCCHARITABLE AND EDUCATION$3,000
FAMILIES IN TRANSITION
199 MANCHESTER STREETMANCHESTERNH03103NONEPCCHARITABLE AND EDUCATION$1,000
FAST FRIENDS GREYHOUND ADOPTION
PO BOX 10093SWANZEYNH03446NONEPCCHARITABLE AND EDUCATION$110
FEED MY STARVING CHILDREN
1072 NATIONAL PARKWAYSCHAUMBURGIL60173NONEPCCHARITABLE AND EDUCATION$4,135
FEEDING AMERICA
35 E WACKER DRIVE SUITE 2000CHICAGOIL60601NONEPCCHARITABLE AND EDUCATION$175
FEEDING AMERICA (WASHINGTON DC)
PO BOX 96749WASHINGTONDC200906749NONEPCCHARITABLE AND EDUCATION$36
FIRST WASHINGTON
21238 68TH AVE SKENTWA98032NONEPCCHARITABLE AND EDUCATION$3,000
GIGI'S PLAYHOUSE
2350 W HIGGINS RDHOFFMAN ESTATESIL60169NONEPCCHARITABLE AND EDUCATION$14,000
GLOBALGIVING
1 THOMAS CIRCLE NW SUITE 800WASHINGTONDC20005NONEPCCHARITABLE AND EDUCATION$250
GRANT TOWNSHIP AREA ATHLETIC ASSOCIATION
PO BOX 103FOX LAKEIL600200103NONEPCCHARITABLE AND EDUCATION$200
GREAT PLAINS ZEN CENTER
W7762 FALK RDMONROEWI53566NONEPCCHARITABLE AND EDUCATION$2,000
GUADALUPE COMMUNITY SERVICES CENTER
21600 HART STREETCANOGA PARKCA91303NONEPCCHARITABLE AND EDUCATION$1,500
HABITAT FOR HUMANITY OF NORTHERN FOX VALLEY
56 SOUTH GROVE AVENUEELGINIL60120NONEPCCHARITABLE AND EDUCATION$5,000
HEALTHCORPS INC
33 IRVING PLACE 3RD FLOORNEW YORKNY10003NONEPCCHARITABLE AND EDUCATION$35,000
HINES FISCHER VA HOUSE
5000 S 5TH AVEHINESIL60141NONEPCCHARITABLE AND EDUCATION$500
HOPE4HARPER
PO BOX 116952CARROLLTONTX75011NONEPCCHARITABLE AND EDUCATION$4,425
HUNDRED NIGHTS SHELTER
PO BOX 833KEENENH03431NONEPCCHARITABLE AND EDUCATION$500
INTERNATIONAL MEDICAL CORPS
12400 WILSHIRE BLVD SUITE 1500LOS ANGELESCA90025NONEPCCHARITABLE AND EDUCATION$500
INTERNATIONAL MYELOMA FOUNDATION
12650 RIVERSIDE DRIVE SUITE 206NORTH HOLLYWOODCA916073421NONEPCCHARITABLE AND EDUCATION$1,000
INTERNATIONAL RESCUE COMMITTEE
122 E 42ND STNEW YORKNY10168NONEPCCHARITABLE AND EDUCATION$450
JAMES ADAMS MIDDLE SCHOOL PTSA
11051 34TH AVE NESEATTLEWA98125NONEPCCHARITABLE AND EDUCATION$150
JEWISH FEDERATION OF CINCINNATI
8499 RIDGE ROADCINCINNATIOH45236NONEPCCHARITABLE AND EDUCATION$300
KENNETH YOUNG CENTER
1001 ROHLWING ROADELK GROVE VILLAGEIL60007NONEPCCHARITABLE AND EDUCATION$1,180
KENT SCHOOLS FOUNDATION
12033 SE 256TH STKENTWA980306503NONEPCCHARITABLE AND EDUCATION$3,000
KUOW
4518 UNIVERSITY WAY NE SUITE 310SEATTLEWA981054535NONEPCCHARITABLE AND EDUCATION$275
LA FAMILY HOUSING
7843 LANKERSHIM BLVDNORTH HOLLYWOODCA91605NONEPCCHARITABLE AND EDUCATION$3,000
LAFAYETTE PARTNERS IN EDUCATION
PO BOX 923LAFAYETTECA94549NONEPCCHARITABLE AND EDUCATION$4,000
LAMBS FARM INC
14245 W ROCKLAND ROADLIBERTYVILLEIL60048NONEPCCHARITABLE AND EDUCATION$1,000
LAREDO COLLEGE EDUCATIONAL FOUNDATION
WEST END WASHINGTON STLAREDOTX78040NONEPCCHARITABLE AND EDUCATION$1,500
LEUKEMIA AND LYMPHOMA SOCIETY
3 INTERNATIONAL DR STE 200RYE BROOKNY10573NONEPCCHARITABLE AND EDUCATION$200
LOST OUR HOME PET RESCUE
2323 SOUTH HARDY DRIVETEMPEAZ85282NONEPCCHARITABLE AND EDUCATION$1,000
LUPUS LA
8383 WILSHIRE BLVD SUITE 232BEVERLY HILLSCA90211NONEPCCHARITABLE AND EDUCATION$2,500
M4K LYNCHBURG
1611 LANGHORNE RDLYNCHBURGVA24503NONEPCCHARITABLE AND EDUCATION$70
MANSFIELD IND SCHOOL DISTRICT
609 E BROAD STREETMANSFIELDTX76063NONEPCCHARITABLE AND EDUCATION$1,000
MARCH OF DIMES GREATER CHARLOTTE
4833 E BEREWICK TOWN CTR DR E177CHARLOTTENC28278NONEPCCHARITABLE AND EDUCATION$3,370
MARINE TOYS FOR TOTS FOUNDATION
18251 QUANTICO GATEWAY DRTRIANGLEVA22172NONEPCCHARITABLE AND EDUCATION$75
MARKLUND
1 SOUTH 450 WYATT DRIVEGENEVAIL60134NONEPCCHARITABLE AND EDUCATION$4,000
MEND-MEET EACH NEED WITH DIGNITY
10641 N SAN FRANCISCO ROADPACOIMACA91331NONEPCCHARITABLE AND EDUCATION$3,000
MICHAEL J FOX PARKINSON FOUNDATION
PO BOX 4777NEW YORKNY101634777NONEPCCHARITABLE AND EDUCATION$100
MOCO ARTS
76 RAILROAD STREETKEENENH03431NONEPCCHARITABLE AND EDUCATION$260
MOMENTOUS INSTITUTE
106 EAST 10TH STREETDALLASTX752032236NONEPCCHARITABLE AND EDUCATION$200
MONADNOCK HUMANE SOCIETY
101 W SWANZEY ROADSWANZEYNH03446NONEPCCHARITABLE AND EDUCATION$256
MONTESSORI SCHOOLHOUSE OF CHESHIRE COUNTY INC
28 HURRICANE ROADKEENENH03431NONEPCCHARITABLE AND EDUCATION$260
NATIONAL MERIT SCHOLARSHIP CORPORATION
1560 SHERMAN AVE STE 200EVANSTONIL602014897NONEPCCHARITABLE AND EDUCATION$24,200
NATIONAL MS SOCIETY
PO BOX 4527NEW YORKNY10163NONEPCCHARITABLE AND EDUCATION$100
NEVADA CITY SCHOOL OF THE ARTS
13032 BITNEY SPRINGS RDNEVADA CITYCA95959NONEPCCHARITABLE AND EDUCATION$400
NEW HAMPSHIRE FOOD BANK
700 E INDUSTRIAL PARK DRMANCHESTERNH03109NONEPCCHARITABLE AND EDUCATION$750
NEW HAMPSHIRE PUBLIC RADIO
PO BOX 9645MANCHESTERNH03108NONEPCCHARITABLE AND EDUCATION$250
NORTH CENTRAL COLLEGE
30 N BRAINARD STNAPERVILLEIL60540NONEPCCHARITABLE AND EDUCATION$8,500
NORTHERN ILLINOIS FOOD BANK
273 DEARBORN COURTGENEVAIL60134NONEPCCHARITABLE AND EDUCATION$3,250
NORTHERN ILLINOIS UNIVERSITY FOUNDATION
1425 LINCOLN HIGHWAYDEKALBIL60115NONEPCCHARITABLE AND EDUCATION$17,500
NORTHWEST HARVEST
PO BOX 12272SEATTLEWA98102NONEPCCHARITABLE AND EDUCATION$3,000
NUTRITIONAL THERAPY FOR IBD
921 PINE HALLOW ROADMOUNT PLEASANTSC29464NONEPCCHARITABLE AND EDUCATION$1,000
OKEMOS OUTREACH
2800 JOLLY ROADOKEMOSMI48864NONEPCCHARITABLE AND EDUCATION$535
OLIVE BRANCH MISSION
6310 S CLAREMONT AVECHICAGOIL60636NONEPCCHARITABLE AND EDUCATION$250
OPEN HEART KITCHEN
1141 CATALINA DR MAILBOX 137LIVERMORECA94550NONEPCCHARITABLE AND EDUCATION$3,000
OPERATION GRATITUDE
PO BOX 260257ENCINOCA914260257NONEPCCHARITABLE AND EDUCATION$2,500
OPERATION SMILE
3641 FACULTY BLVDVIRGINIA BEACHVA23453NONEPCCHARITABLE AND EDUCATION$100
PANCREATIC CANCER ACTION NETWORK
1500 ROSECRANS AVE STE 200MANHATTAN BEACHCA90266NONEPCCHARITABLE AND EDUCATION$500
PLEASANTON PARTNERS IN EDUCATION
4659 B BERNAL AVEPLEASANTONCA94566NONEPCCHARITABLE AND EDUCATION$10,000
PORTAL SCHOOL COMMUNITY ORGANIZATION
1188 WUNDERLICH DRIVESAN JOSECA95129NONEPCCHARITABLE AND EDUCATION$825
RESPIRATORY HEALTH ASSC OF MET
1440 W WASHINGTON BLVDCHICAGOIL606071878NONEPCCHARITABLE AND EDUCATION$20,000
ROBOTICS EDUCATION AND COMPETITION
1519 I-30 WESTGREENVILLETX75402NONEPCCHARITABLE AND EDUCATION$5,000
SAFE FAMILIES FOR CHILDREN NATIONAL
4300 W IRVING PARK ROADCHICAGOIL60641NONEPCCHARITABLE AND EDUCATION$1,750
SAIL SAND POINT
7861 62ND AVE NESEATTLEWA98115NONEPCCHARITABLE AND EDUCATION$3,650
SAINT VINCENT DE PAUL SOCIETY
5972 4TH AVE SOUTHSEATTLEWA98108NONEPCCHARITABLE AND EDUCATION$400
SALVATION ARMY OF NORTHEAST FLORIDA
5631 VAN DYKE ROADLUTZFL33558NONEPCCHARITABLE AND EDUCATION$250
SAMARITAN'S PURSE
PO BOX 3000BOONENC28607NONEPCCHARITABLE AND EDUCATION$350
SAN FERNANDO VALLEY RESCUE MISSION
PO BOX 8073VAN NUYSCA914098073NONEPCCHARITABLE AND EDUCATION$2,500
SHS FIRST ROBOTICS
70 THORNTON FERRY ROAD IIAMHERSTNH03031NONEPCCHARITABLE AND EDUCATION$1,750
SOMEBODY CARES ST AUGUSTINE
PO BOX 840081ST AUGUSTINE BEACHFL32080NONEPCCHARITABLE AND EDUCATION$750
SPECIAL CHILDREN'S CHARITIES
2 EAST 8TH ST SUITE 2MCHICAGOIL60605NONEPCCHARITABLE AND EDUCATION$198
ST JOSEPH SCHOOL OF FREMONT
43222 MISSION BLVDFREMONTCA94539NONEPCCHARITABLE AND EDUCATION$100
ST JUDE CHILDRENS RESEARCH HOSPITAL
5501 N CUMBERLAND AVECHICAGOIL60656NONEPCCHARITABLE AND EDUCATION$75
ST VINCENT DEPAUL OF KING COUNTY
5950 FOURTH AVE SOUTHSEATTLEWA98108NONEPCCHARITABLE AND EDUCATION$400
ST CATHERINE SCHOOL
8524 8TH AVENUE NESEATTLEWA98115NONEPCCHARITABLE AND EDUCATION$500
ST FRANCIS HOUSE
70 WASHINGTON STST AUGUSTINEFL32084NONEPCCHARITABLE AND EDUCATION$1,250
STRAIGHT OUTTA TEXAS
15406 HYDE PARK DRIVECYPRESSTX77429NONEPCCHARITABLE AND EDUCATION$100
TAILS HUMANE SOCIETY
2250 BARBER GREENE ROADDEKALBIL60115NONEPCCHARITABLE AND EDUCATION$100
THE HARBOUR
1440 RENAISSANCE DR STE 240PARK RIDGEIL60068NONEPCCHARITABLE AND EDUCATION$4,300
THE NASHUA CENTER
18 SIMON STREETNASHUANH03060NONEPCCHARITABLE AND EDUCATION$3,000
THE NATURE CONSERVANCY
PO BOX 1556MERRIFIELDVA221169590NONEPCCHARITABLE AND EDUCATION$500
THE SALVATION ARMY
615 SLATERS LANE PO BOX 269ALEXANDRIAVA22314NONEPCCHARITABLE AND EDUCATION$100
THE TREVOR PROJECT
PO BOX 69232WEST HOLLYWOODCA90069NONEPCCHARITABLE AND EDUCATION$100
THE WAY TO HAPPINESS FOUNDATION
201 EAST BROADWAYGLENDALECA91201NONEPCCHARITABLE AND EDUCATION$200
THE WHIDBEY INSTITUTE
6449 OLD PIETILA RDCLINTONWA98236NONEPCCHARITABLE AND EDUCATION$4,000
TRINITY UNIVERSITY
ONE TRINITY PLACESAN ANTONIOTX78212NONEPCCHARITABLE AND EDUCATION$100
TUNNEL TO TOWERS FOUNDATION
2361 HYLAN BLVDSTATEN ISLANDNY10306NONEPCCHARITABLE AND EDUCATION$100
UC MERCED FOUNDATION
5200 NORTH LAKE ROADMERCEDCA95343NONEPCCHARITABLE AND EDUCATION$15,000
UNH SHARPP
2 PETTEE BROOK LANEDURHAMNH03824NONEPCCHARITABLE AND EDUCATION$500
UNICEF USA
125 MAIDEN LANENEW YORKNY10038NONEPCCHARITABLE AND EDUCATION$900
UNITED NATIONS FOUNDATION
1750 PENNSYLVANIA AVE NW SUITE 300WASHINGTONDC20006NONEPCCHARITABLE AND EDUCATION$100
UNIVERSITY OF HOUSTON
PO BOX 867HOUSTONTX770010867NONEPCCHARITABLE AND EDUCATION$21,360
UNIVERSITY OF MICHIGAN DEARBORN
4901 EVERGREEN RD 1040BDEARBORNMI48128NONEPCCHARITABLE AND EDUCATION$100,000
USA FOR UNHCR
1310 L ST NW SUITE 450WASHINGTONDC20005NONEPCCHARITABLE AND EDUCATION$320
WATER ORG
117 WEST 20TH STREET SUITE 203KANSAS CITYMO64108NONEPCCHARITABLE AND EDUCATION$25
WEST SEATTLE FOOD BANK
3419 SW MORGAN STSEATTLEWA98126NONEPCCHARITABLE AND EDUCATION$150
WESTSIDE BABY
10002 14TH AVE SWSEATTLEWA98146NONEPCCHARITABLE AND EDUCATION$3,200
WESTVIEW FOUNDATION
13500 CAMINO DEL SURSAN DIEGOCA92129NONEPCCHARITABLE AND EDUCATION$450
WORLD WILDLIFE FUND
1250 24TH ST NWWASHINGTONDC200371175NONEPCCHARITABLE AND EDUCATION$500
YAKIMA VALLEY COMMUNITY FOUNDATION
111 UNIVERSITY PARKWAY SUITE 102YAKIMAWA98901NONEPCCHARITABLE AND EDUCATION$108
YOUTH BICYCLISTS OF NEVADA COUNTY FOUNDATION
221 BOULDER STREETNEVADA CITYCA95959NONEPCCHARITABLE AND EDUCATION$100
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$538,900TotalGrantOrContriPdDurYrAmt
Total Grant Or Contri Apprv Fut$0TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$911ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion$773ExclusionAmt

Other Revenue Described OtherRevenueDescribedGrp

FieldValueIRS element (for citing)
DescREFUND FROM FEDERAL EXCISE TAXDesc
Exclusion01ExclusionCd
Exclusion$170ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$1,854ExclusionAmt
Related Or Exempt Function Incm$0RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$1,854TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO0RelationshipsNonchrtblEOInd

Schedule B IRS990ScheduleB

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
General RuleYes (X)GeneralRuleInd

Contributor Information ContributorInformationGrp (4 entries)

ContributorContributorNumAddress Line1ContributorUSAddress/AddressLine1TxtCityContributorUSAddress/CityNmState AbbreviationContributorUSAddress/StateAbbreviationCdZIPContributorUSAddress/ZIPCdTotal ContributionsTotalContributionsAmtPerson ContributionPersonContributionIndAddress Line1ContributorForeignAddress/AddressLine1TxtCityContributorForeignAddress/CityNmProvince Or StateContributorForeignAddress/ProvinceOrStateNmCountryContributorForeignAddress/CountryCdForeign PostalContributorForeignAddress/ForeignPostalCd
OMRON HEALTHCARE INC
11925 WEST FIELD COURTLAKE FORESTIL60045$85,692Yes (X)
OMRON ELECTRONIC COMPONENTS LLC
22895 GREENSPOINT PARKWAYHOFFMAN ESTATESIL60169$59,818Yes (X)
OMRON ELECTRONICS LLC
32895 GREENSPOINT PARKWAYHOFFMAN ESTATESIL60169$42,759Yes (X)
OMRON CANADA INC
4$19,037Yes (X)802 - 100 CONSILIUM PLACESCARBOROUGHONCAM1H 3E3

Investments Other Schedule2 InvestmentsOtherSchedule2

Investments Other InvestmentsOtherGrp

FieldValueIRS element (for citing)
Category Or ItemFIDELITY ASSET MANAGERCategoryOrItemTxt
Listed At Cost Or FMVAT COSTListedAtCostOrFMVCd
Book Value$300,011BookValueAmt
EOYFMV$300,783EOYFMVAmt

Other Decreases Schedule OtherDecreasesSchedule

Other Decreases Detail OtherDecreasesDetail

FieldValueIRS element (for citing)
DescUNREALIZED LOSSDesc
Amt$772Amt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp

FieldValueIRS element (for citing)
DescBANK FEESDesc
Revenue And Expenses Per Books$4,293RevenueAndExpensesPerBooksAmt
Net Investment Income$4,293NetInvestmentIncomeAmt
Disbursements Charitable Prps$0DisbursementsCharitablePrpsAmt

Other Income Schedule2 OtherIncomeSchedule2

Other Income Detail OtherIncomeDetail

FieldValueIRS element (for citing)
DescREFUND FROM FEDERAL EXCISE TAXDesc
Revenue And Expenses Per Books$170RevenueAndExpensesPerBooksAmt
Adjusted Net Income$170AdjustedNetIncomeAmt

Other Increases Schedule OtherIncreasesSchedule

Other Increases Detail OtherIncreasesDetail

FieldValueIRS element (for citing)
DescRECOVERY OF PRIOR YEAR QUALIFIED DISTRIBUTIONSDesc
Amt$300Amt

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail

FieldValueIRS element (for citing)
CategoryIL ATTORNEY GENERALCategoryTxt
Amt$15Amt
Net Investment Income$0NetInvestmentIncomeAmt
Disbursements Charitable Prps$15DisbursementsCharitablePrpsAmt